July 3, 2008 -Attention Outpatient Hospitals: MDCH implemented a systems change for Outpatient claims processed on/after Pay Cycle 27 which has caused an error in adjudication of all OPH claims. While some claims may have priced correctly off of the Procedure code, the adjudication error off of the Revenue code has caused additional rejections for edit 552 (Duplicate claim/line) and also caused the Revenue codes to display on all claim lines on the Remittance Advice. MDCH will be generating claim adjustments for all outpatient claims affected by this issue once the systems error has been corrected.
July 2, 2008 -
Attention Private Duty Nursing: MDCH is reminding PDN staff to clock out at 11:59 p.m. and back in at midnight if they are working an overnight holiday shift. Doing so will avoid corrections for holiday pay.
June 30, 2008 -
A MP614 report is a front end report that generates when a claim was submitted and is not associated to a legacy ID in the Medicaid System. This claim will not go any further in the system and will not appear on a remittance advice. The following are reasons for these claims to reject to an MP614 report. The top 3 reasons are as follows:
1. NPI number reported on claim is not in the Medicaid System
2. Reporting a Group NPI (type 2) number not a Rendering NPI (type 1) number.
3. The legacy ID number has an eligibility end date. Provider would need to re-enroll.
When any of these situations above occur a MP614 report is generated back to the Billing Agent that submitted the claim. The Billing Agent in turn will send the report back to the Provider that submitted the claim.
June 26, 2008 - Effective pay date 10/01/2007 or after, services billed properly for family planning using a FAO Group Billing NPI number (type 2) and a Rendering Health Officer NPI number (type 1) will be paid at the proper 90% reimbursement during time of settlement if a family planning diagnosis was on the claim.
Many Health Departments may notice that office visits for these services may crosswalk and pay based on the legacy provider type 77 health officer number. Just remember to use the correct family planning diagnosis code, correct billing NPI, and rendering NPI numbers for these services to ensure proper reimbursement.
June 13, 2008 - CMS approved a six-month extension for reporting NDCs through 6-30-08. MDCH recently worked with the Michigan Hospital Association (MHA) for another extension on behalf of Medicaid enrolled OPHs however CMS has formally denied this request. MDCH will implement the NDC policy reporting requirement per MSA 08-02.
Effective for dates of service (DOS) on and after July 1, 2008, Outpatient Hospital Providers (OPHs) are required to report the National Drug Code (NDC) for physician administered drugs as described in MSA policy bulletins 08-02 (prior MSA 07-33, 07-61) and Section 6.12 Billing & Reimbursement for Institutional Providers of the Manual. Providers are not required to report packaged/bundled Medicare Status Indicator (SI/N) NDCs. Edit 955 will set at the claim line level if the NDC is not reported appropriately.
340B hospitals are required to billactual acquisition cost of a drug if purchased at the 340B price per federal law as part of their participation in the 340B Program. Providers must report the appropriate NDC, and MDCH may recoup payment(s) for billings in violation of this policy.
June 6, 2008 - Attention Private Duty Nursing- Provider Types 10 and 15: MDCH has identified duplicate payments for Private Duty Nursing providers. Claims will be taken back in the near future.
March 27, 2008
- MDCH would like to inform Outpatient (PT40) providers that systems changes to implement January 2008 OPPS/APC updates have been completed effective pay cycle 11 dated 3/12/08. The MDCH will initiate claim adjustments for any Outpatient claims with 2008 dates of service that have paid prior to pay cycle 11. Claims with 2008 dates of service that have been rejected with the 841 edit will also be resubmitted. The first batch of adjustments will be for claims with January 1st-15th dates of service and should appear on the remittance advice dated 4/3/08, pay cycle 14. The remainder of claims to be adjusted should appear on the remittance advice dated 4/10/08, pay cycle 15.
March 25, 2008
- August 2006, NUBC restricted the use of value codes for reporting deductible/co-insurance/co-pay amounts (A1, A2, A7, B1, B2 & B7, C1, C2 & C7) to paper claims only. This change was implemented by Medicare for claims with dates of service on/after July 1, 2007. MDCH will be implementing this change for Inpatient and Outpatient Hospitals institutional claims on May 1, 2008. Providers must report deductible/co-insurance/co-pay amounts using CAS codes, rather than value codes, for all Michigan Fee-For-Service Medicaid electronic inpatient and outpatient claims with date of service July 1, 2007 and after. All claims with dates of service prior to July 1, 2007 must be reported with value codes. In April, MDCH will set edit 415 informational on all electronic IPH/OPH claims that do not contain CAS segments for co-ins/ded/copays. Starting in May, MDCH will begin rejecting electronic claims with dates of service on or after July 1, 2007 that have Value Codes only reported. March 21, 2008 - Attention Public Health Agencies:
The Michigan Department of Community Health (MDCH) again offers its many apologies for the persisting billing issues affecting MIHP Providers, Family Planning Clinics, and Public Health Agencies. The Department realizes that this is beyond an inconvenience to your organizations. A dedicated group of MDCH staff continue to work diligently and consistently to unravel the confounding relationships between old edit logic and newer NPI crosswalk logic causing these problems. The latest strategy, involving re-enrolling all affected providers that we are able to identify, is still being tested. Other updates to claims editing logic will be tested this week.
Currently, Vision, Hearing and Dental claims are adjudicating properly. Vision, Hearing, and Dental claims should report both a Billing and Rendering NPI. MIHP Provider and Family Planning Clinic claims are not adjudicating properly due to issues with the Rendering NPI. A separate test to fix this issue will be complete late next week. It is very important that MIHP and Family Planning claims have both a Billing and a Rendering NPI for annual reporting and program integrity therefore these claims must not be submitted until this issue has been resolved. Immunization and Blood Lead procedures are currently experiencing NPI issues at both the Billing and Rendering NPI levels. NPI issues with MIHP, Family Planning, Immunizations, and Blood Lead procedures are occurring regardless of single or multiple enumeration.
MDCH would also like to make it clear that claims affected by these NPI issues are exempt from the 12 month billing limitation. Until CHAMPS is available for claims adjudication, Public Health claims affected by NPI implementation can be submitted for dates of service up to 2 years old. This will ensure that we can all still benefit from proper data collection for both payment and reporting purposes.
MDCH is also aware of several NPI transmission issues with claims received from Netwerkes. The Department is working with Netwerkes to resolve these issues.
LHDs requesting advance payment for Fee For Service claims should email providersupport@michigan.gov with "LHD Advance" in the subject heading and the NPI, the dollar amount requested, a brief explanation of what the dollar amount represents and why an advance is being requested, provider/LHD/Director name, contact person, and phone number.
Advance payments are not considered payment for services rendered. Advance payments would appear as a gross adjustment on a remittance advice as a lump sum to be recovered by a negative gross adjustment later and reconciled by proper claim adjudication when the system is fixed.
It has been a very unique struggle to transition these Public Health providers' enrollments from a single, combination-rendering/billing ID claim edit method to a two-NPI per claim edit method. We appreciate the hard work and patience of you and your staff to help us resolve this issue as quickly and effectively as possible.
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July 3, 2008 -
Attention Outpatient Hospitals: MDCH implemented a systems change for Outpatient claims processed on/after Pay Cycle 27 which has caused an error in adjudication of all OPH claims. While some claims may have priced correctly off of the Procedure code, the adjudication error off of the Revenue code has caused additional rejections for edit 552 (Duplicate claim/line) and also caused the Revenue codes to display on all claim lines on the Remittance Advice. MDCH will be generating claim adjustments for all outpatient claims affected by this issue once the systems error has been corrected.
